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A Growing Concern: The Emergence and Dissemination of Carbapenemase-producing Enterobacterales (CPE) in Canada

Published online by Cambridge University Press:  02 November 2020

Robyn Mitchell
Affiliation:
Public Health Agency of Canada
Laura Mataseje
Affiliation:
National Microbiology Laboratory
David Boyd
Affiliation:
National Microbiology Laboratory, Public Health Agency of Canada
Ghada Al-Rawahi
Affiliation:
BC Childrens Hospital
Ian Davis
Affiliation:
Queen Elizabeth II Health Sciences Centre
Chelsey Ellis
Affiliation:
Horizon Health Network, Moncton, The Moncton Hospital, Moncton
Joanne Embree
Affiliation:
Health Sciences Centre, Winnipeg, MB
Susy Hota
Affiliation:
University Health Network
Pamela Kibsey
Affiliation:
Royal Jubilee Hospital
pital Maisonneuve-Rosemont
Affiliation:
Montreal, QC
Jerome Leis
Affiliation:
University of Toronto
Allison McGeer
Affiliation:
Mount Sinai Hospital
Jessica Minion
Affiliation:
Regina Qu'Appelle Health Region
Appelle Health Region
Affiliation:
Regina, SK
Michael Mulvey
Affiliation:
National Microbiology Laboratory
Sonja Musto
Affiliation:
Health Sciences Centre, Winnipeg, MB
Linda Pelude
Affiliation:
Public Health Agency of Canada
Jocelyn Srigley
Affiliation:
BC Children's & Women's Hospitals
Stephanie Smith
Affiliation:
University of Alberta
Kathryn N. Suh
Affiliation:
The Ottawa Hospital, Ottawa, ON
Geoffrey Taylor
Affiliation:
University of Alberta Hospital, Edmonton, AB
Nisha Thampi
Affiliation:
Children's Hospital of Eastern Ontario
Titus Wong
Affiliation:
Vancouver General Hospital, Vancouver, BC
Kevin Katz
Affiliation:
North York General Hospital
CNISP PHAC
Affiliation:
Public Health Agency of Canada
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Abstract

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Background: Carbapenemase-producing Enterobacterales (CPE) have rapidly become a global health concern and are associated with substantial morbidity and mortality due to limited treatment options. Travel to endemic areas, especially healthcare exposure in these areas, is an important risk factor for acquisition. We describe the evolving epidemiology, molecular features, and outcomes of CPE in Canada through surveillance by the Canadian Nosocomial Infection Surveillance Program (CNISP). Methods: CNISP has conducted surveillance for CPE among inpatients and outpatients of all ages since 2010. Participating acute-care facilities submit eligible specimens to the National Microbiology Laboratory for detection of carbapenemase production, and epidemiological data are collected. Incidence rates per 10,000 patient days are calculated based on inpatient data. Results: In total, 59 CNISP hospitals in 10 Canadian provinces representing 21,789 beds and 6,785,013 patient days participated in this surveillance. From 2010 to 2018, 118 (26%) CPE-infected and 547 (74%) CPE-colonized patients were identified. Few pediatric cases were identified (n = 18). Infection incidence rates remain low and stable (0.02 per 10,000 patient days in 2010 to 0.03 per 10,000 patient days in 2018), and colonization incidence rates have increased by 89% over the surveillance period. Overall, 92% of cases were acquired in a healthcare facility: 61% (n = 278) in a Canadian healthcare facility and 31% (n = 142) in a healthcare facility outside Canada. Of the 8% of cases not acquired in a healthcare facility, 50% (16 of 32) reported travel outside of Canada in the 12 months prior to positive culture. The distribution of carbapenemases varied by region; New Delhi metallo-B-lactamase (NDM) was dominant (59%) in western Canada and Klebsiella pneumoniae carbapenemase (KPC) (66%) in central Canada. NDM and class D carbapenemase OXA-48 were more commonly identified among those who traveled outside of Canada, whereas KPC was more commonly identified among patients without travel. In addition, 30-day all-cause mortality was 14% (25 of 181) among CPE infected patients and 32% (14 of 44) among those with bacteremia. Conclusions: CPE rates remain low in Canada; however, national surveillance data suggest that the increase in CPE in Canada is now being driven by local nosocomial transmission as well as travel and healthcare within endemic areas. Changes in screening practices may have contributed to the increase in colonizations; however, these data are currently lacking and will be collected moving forward. These data highlight the need to intensify surveillance and coordinate infection control measures to prevent further spread of CPE in Canadian acute-care hospitals.

Funding: None

Disclosures: Susy Hota reports contracted research for Finch Therapeutics. Allison McGeer reports funds to her institution for projects for which she is the principal investigator from Pfizer and Merck, as well as consulting fees from the following companies: Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.

Type
Poster Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.